title: Risperidone, QTc interval prolongation, and torsade de pointes: a systematic review of case reports.
abstract: BACKGROUND
  A recent publication asserted that even low-dose risperidone may induce corrected QT (QTc) interval prolongation up to 500 ms without drug-induced IKr blockade. We seek to better understand the complexity of any link between risperidone-induced/associated QTc interval prolongation and torsade de pointes (TdP).
  
  
  OBJECTIVE
  The objective of this study is to systematically analyze all available case reports of risperidone, QTc interval prolongation, and/or TdP.
  
  
  METHODS
  We identify case reports using PubMed, Medline, EMBASE, and Cochrane.
  
  
  RESULTS
  Of the 15 cases found, nine were adult women (ages 31, 33, 34, 37, 47, "elderly", 77, 84, and 87 years) and one was a teenager. There were four men (ages 28, 29, 29, and 46 years) and one preadolescent boy. Besides risperidone administration or overdose, traditional risk factors for QTc interval prolongation and TdP included female sex (n = 10), older age (n = 4), heart disease (n = 3), hypokalemia (n = 2), bradycardia (n = 1), liver disease (n = 1), QTc interval prolonging drugs other than risperidone (n = 8), and metabolic inhibitors (n = 2). TdP occurred in four cases. Six patients died, and three deaths were probably related to TdP.
  
  
  CONCLUSIONS
  Risperidone (when properly prescribed in patients free of other risk factors for QTc interval prolongation and TdP) is a relatively safe drug. Conventional statistics can neither predict the individual patient who will experience TdP nor determine the relationship of drug dose to QTc interval prolongation and TdP. Narrative medicine using a case report format appears to be an alternative and valuable additional approach to advance our understanding of this relationship and to reduce risks.
authors.affiliation: Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.VicVieweg@GMail.com
authors.forename: W Victor R
authors.initials: WV
authors.lastname: Vieweg
authors.forename: Mehrul
authors.initials: M
authors.lastname: Hasnain
authors.forename: Jules C
authors.initials: JC
authors.lastname: Hancox
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
authors.forename: Geneviève C
authors.initials: GC
authors.lastname: Digby
authors.forename: Christopher
authors.initials: C
authors.lastname: Kogut
authors.forename: Ericka L Breden
authors.initials: EL
authors.lastname: Crouse
authors.forename: Jayanthi N
authors.initials: JN
authors.lastname: Koneru
authors.forename: Anand
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Ananda K
authors.initials: AK
authors.lastname: Pandurangi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects*; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone